23C-016 (3) 543 RIVERSIDE DR BP-2020-1200
GIS#: COMMONWEALTH OF MASSACHUSETTS
ME-.Block:23C-016 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A)
Category:window replaced BUILDING PERMIT
Permit# BP-2020-1200
Proiect# JS-2020-002011
Est.Cost: $28026.00
Fee: $182.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor., License:
Use Group: MICHAEL PHILLIPS 082683
Lot Size(sq. ft.): 47916.00 Owner: HAMLIN REBECCA
zoning: URB(100)/ Applicant: MICHAEL PHILLIPS
AT. 543 RIVERSIDE DR
Applicant Address: Phone: Insurance:
P O BOX 514 (41'3) 250-7990 O WC
GOSHENMA01032 ISSUED ON.6/4/2020 0:00.00
TO PERFORM THE FOLLOWING WORK.-INSTALL NEW WINDOWS, FRAME INTERIOR
WALLS, SHEETROCK
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final•
Rough Frame:
Gas: Fire Department Fireplace/Chhmie�:
Rough: Oil: Insulation:
Final: Smoke: Final•
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy signature:
Ii eeTyne: Date Paid: Amount:
Building 6/4/2020 0:00:00 $182.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Department use only -
City of Northalnpt. - Status of Permit
Building C}e artrnnt
€� p �b Cut'Lriuewray Permit
212 Main Strivet ��� �'�r1S°eptic Availability _
s Room 1 /, ,Avaiiabili� —
NCrthampton, (Uik 6Q G�Q,�r� T o Structural Plansprone 413-,587-1240 Ea 4 -1272 lot# rrs
0they
APPLICATION TO CONSTRUCT,ALTER,REPAIR,REN DE OLISH A ONE OR TWO FAMILY DWELLING
SECTION 7 -SITE INFORMATION
1.1 ProDertir Address. This section to be completed by office
K Ma
P Lot Unit
"• _
' zone Overlay tJ�Isfrict
Elm 9t,District—_ CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED ANENT
2.1 Owner of Record:
Na Print Current Mailing Address:
r... t Telephone
2,2 Authorized A ent: (� 3
Name(Pi � Y � �urnerst Nlalili�ryg�A�fdress:
SignatuEe Telephrane
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cast(Dollars)to be Official Use Only
completed by permit a Iicant
1. Building �` (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(fi}
3. Plumbing Building Permit Fee
4 Mechanical(HVAC)
5. Fire Protection
S. 'Total=0 +2+3+4+5t Check Number4-4
TI►i &( tion For Official Use Only
Building Permit Numb r / Issued:--
ed,
�-0
Signature: - 6- q.Z620 _
Budd" q vornrni inner/Inspector of 80idings
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING All information Must Be Completed.Permit Can Be Denied Rue To Incomplete information04
1,xisting Proposed Required by Zoning
Tbis column to be filed in by
Building Department
E
Lot size
Frontage
Setbacks f fgn.t.
Side i L: It:
Rear
Building Height
Bldg. Square Footage � alp
Open Space Footage °a
(I.,ot area minas bldg&paved
parking)
i of Parkins!Spaces
Fill:
volume K Location)
)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW 0 YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW YES
IF YES: enter Book Page and/or Document
B. Does the site dontain a brook,body of water or wetlands? NO 0 DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 Date Issued:
C. Do any signs exist on the property? YES 0 NO 0
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO
IF YES, describe size, type and tocation:
E Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors
Accessory Bldg ❑ Demolition ❑ New Signs ro] Decks 1C Siding M;Ir Other
Brief Description of Procosed
Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
fa_ If New house and or addition to existinq housing,complete the following:
a. Use of building , One Famiiy Two Family Other-
b, Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g, Energy Conservation Compliance. Mamheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft of wetlands) Yes No, Is construction within 100 yr, floodplain-Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? -Yes No.
1, Septic Tank_ City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
...................................... as Owner of the subject
property
hereby authorize
to act on,, _�be alf, in all matters lativelto wbrk autho6z�d bV-this b'uiIdiri§p6r,,_nit application
0 - 1 7
....... 51 012
0
'Sig na,kw of Owner F Date
i, n1-4v as Owner/Authorized
Agent herebdeclare that.the statehnents a �information the l3nagoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penal 4 of
Print Name
rw L-111 7fl
Signature ol 06nerdA_gDate
SECTION -CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: [ Not Applicable
Name of License Holder
- -�.. t'+'-(
License umber
AddreA Eviration Date
P
Sign T
S
etepnone
,r
8.Reciistered Home Im rc++r en ntractor: Not Apjp`licable D
# e4 if I
Registrawn N tuber
61 4J 04o
Ad rens Expirati n Date
Telephone xl
a
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6))
Workers Compensabon Insurance affidavit must be completed and submitted with this application Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... No..,.... Q
City of Northampton
Massachusetts
DEPARTMENT )E BUILDING DWECTIONS
211 gain Street • Munscipwl Building
Northampton., MA 01060 rp" 1i
AFFIDAVIT
Home.Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes. Prior to
performing work on such homes,a contractor must be registered as a Home Improvement Contractor("MIC").
M.G..L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion,
improvement, removal, dDrnolition,or construction of an addition to any pre-existing owner-occupied building containing
at least one but not more than four dwelling units—.or to structures which are adjacent to such residence or building"be
done by registered contractors.
.Nate:If the homeowner has contracted with a corporation or LLC,that entity must be registered
Type of Work.: 0- t�-v Est.Cost:,'K-()
Address of Work:
Date of Permit Application:__
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by lain(explain):
_Job under$1,000.00
Owner obtaining own permit(explain): _
Building not owner-occupied
Other
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED CINDER THE BUILDING PERMIT..SEE NEXT PAGE FOR MORE INFORMATION.
Siwned under the penalties of perjury:
I hereby apply for a building permit as the agent of the owner:
LD
Dat ('ontractor Nairn HIC'Registration No.
OR:
Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property
Date Owner Name and Signature
Gita' of Northampton
Massachusetts
s
p DEPARTMXT OF BUILDING INSPECTIONS
L
212 Main Street *Municipal Building
'4
NorthaWton, MA 01060
Debris Disposal Aff ` davit
In accordance of the provisions of MGL c 40. S54, I acknowledge that as a condition of the building
permit all debris resulting from the construction activity governed by this Building Permit shall be disposed
of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
The debris from construction work being performed at:
(please print house n6mher and street name)
Is to be disposed of at.
(Please print name and°tocation ol facility)
Or will be disposed of in a dumpster onsite rented or leased from;
r.
(Company Name and Address)
Signature of Permit Applicant or Own r Date
If, for any reason. the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building (department as to the location where the debris will be disposed.
The Commonwealth t►,f Massachusetts
,,...�.:� Department of IndustrialAccidentc
.1 Congress Street,Suite 100
' Boston,MA 02114-.2017
sstww mass.gos}Idia
Workers'Compensation Insurance Affidavit:Builders/Contrsctors/Eicctriciansli Iuinhers.
TO BE FILED WITH THE PERMITTING At`TFIORM-
Applicant Information Please Print Le ibly
Name(BusinmVo rgani?ationMdividusl):
Address:— !e� -c x
� '�`j E^3
C,
1tV/StatC,rZ-sp: � �� Phone#:
Are you an emptoyer:'t check the appropriate hoar: Type of project(required)'
I-rl I am a employer with _........employees(full and/or part-time)* 7. New construction
2.�t ani u sole prom actor or partnership and have no employees working for me in $. 12fRemodeling
-any ca att-[No workers'romp.insurance rquired.j
9. Demolition
.Q I am a hc�trre:++s z r d- aft work MYSCIf.(tate workers'comp_insurance rrquired i
10 Building addition
4,[]l am a homeowner and will tae hrnng contractors tai conduct aft wo on my pen rt° l will
ensure that all contractor either have worker..'compenudicm insurance to are pair 11,0 Electrical repairs or additions
propnetcwrs with no employe„es 12.n Plumbing repairs or additions
S.Q l am a general contractor and!have hared the sutrcot3tractots listed on the anached shot, 1 .a Roof repairs
Thew&sub-conmac tc�have employees and have workers'camp-insurance=
l4_QOdser
6r1c arate a corporion and its officers have exercised their right of exemption per MGL ci2,g ha
10),and we ve no employees:I.No workers'comp.insurance required.]
*A y appliewit that checks box 41 must ilia fill out the section below showing their workers'compensation POW-.;information.
v Homeowners whoa submit this affidavit indicating they we doing all work and then hire outside contractors must submit a new affidavit indicating such,
"Ccautractors thm check this box must attached an additional sheet showing:the name of sub-contractom and%Mate whether or not those entities have
employers. if the sub-contractors have employees,they must provide their workers ammo p0110 nnnvtWs
I am an enogrer that is proWdiug workers'compensation insurance far cert'e rxplr!t'cc�. Kc/rrx7 is the/tr>liea°tend jr,h site
infcrrmatainn.
Insurance Company Narrte:
Policy#or Self-ins.Lic, _........ Expiration Bate:.
Job Site Address: ., !
—2
s CitvlState�Zip. "Fro r,. �
Attach a copy of the workers'camps ratio»policy declaratio page(showing the policy num r and ezpitxEion date).t
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00
andtor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
dad,.against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification_
I tit,hereby certif under the aced trf �u at the information provided above is true and correct
Si !ature: Ny\ Gate,:_........__. _—
Phone It: .
((ficial use on1r. Do not emelt in this area,to be completed by city or town ofesal
City or Town: Permit/License#
Issuing:Authority(circle tire):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone tf:
f
1
�,
• 12 Block Masonry Sy
-�.--�. Concrete Block
Reinforcing
Stucco
Furring
InsulationLABOR
Partition Framing .
q �6 ' a C
Bracing \ #
l \ � � ,
. . . > . \ \ < . Z. f :
Studs . . Bottom t# Plate
. I$ . ; it . ,
MZ ll q �
ecer � `-
a�
r
aAl`��
a
r
.. Z+ �6 C.S;'''•
MAW
Y
fy
`jiq�
� � �f���� t I Ilu�i •lil II qq mGv .�r
yi
a t �
3
5
a
a
e.
y.
Six.
s '
i.• � h � gra, �, � � I. �-.
L 5
F � M
a
�qb
sl v g g
m
Cummington Supply Customer
18 Main Street 413-634-8868 c7UOTP.TTc)N
Cununington,MA 01026 1-413-634-2118 QUOTE EXPMES
Qwte Not
Cef hied
BILL TO: SHIP TO:
Phone; Fav
QUOTE# STATUS CUSTOMER PO# DATE CREATED
1"'014 Nene Phillips riverside 4/i0/2019
QUOTED BY TERMS S111P VIA PROJECT NAME
dived Delivered on VP Tnx:fi Hamlvn/riverside
LINE# DESCRIPTION QUANTITY U/M SHIP VIA NET PRICE EXTENSION
100-1 26-1100 4 Delivere $200.28 $801.12
Cummington Supply d. on NVP
Ove*-a].1 Unit Size: - ------—
TrustGard, Double Hung, Double Hung, 32 x 61.5 Truck
32" X 61.5" Frame Width = 32, Frame Height = 61.5, Sash Split = Even
Rough: RO Deduction -1/4" x -1/4", New Construction, Thermal -
Sash
Overall RO Color = White o�
32,5" K 62"
Sash Reinforcement = Lock and Keeper bail Only, Composite "
Unit 1: Glazing Type = Low E, Low E Softcoat, Gas FT11 = J
Tag/Room: Argon
facing brick wail Unit 1 Lower Glass, 1 Upper Glass: Glass Strength =
Single Strength 32
RO-32.5 —
i
I✓
QUOTE# STATUS CUSTOMER PO# DATE CREATED
233614 None pHfips riN-erside 4/30/2019
QUOTED BY TERMS SHIP VIA PROJECT NAME
dreetl Deli-,-erect on NVP Trick Hamhn/ri-,-erside
LINE # DESCRIPTION QUANTITY U/M SHIP VIA NET PRICE EXTENSION
200-1 26-1100 4 Delivere $218.70 $874.80
Overall Unit Size:
Cummington supply d on NVP TrustGard, Double Hung, Double Hung, 40.5 x 61.5
Truck
4A.5^ X 61,5^ Frame Width = 40.5, Frame Height = 61.5, Sash Split =
Rough: Even
RO Deduction = -1/4" x -1/4", New Construction, Thermal N
Overall RO Sash ac
41" X 62" Color = White
Sash Reinforcement = Lock and Keeper Rail Only, composite
Tag/Room: Unit 1: Glazing Type - Low E, Low E Softcoat, Gas FIll =
tae3ng:Y Argon
Unit 1 Lower Glass, 1 Upper Glass: Glass Strength = 406
�-- Rd•a 1 --
Single Strength
Lock Options = Double Lock, Standard, white
Full Screen, Fiberglass
QB Series = 26, QB Item Number = 1100
Unit 1: Unit CPD Number = NVP-K-14-00740-00001, Unit
U-Factor = 0.27, Unit SHGC = 0.28, Unit VT = 0.52, Unit J ,
CR = 62, Air Infiltration Rating = < 0.3 cfm/ft2, Meets
Energy Star = Yes
Unit 1 Lower Glass, 1 Upper Glass: CPD Number =
NVP-K-14-00740-00001, U-Factor = 0.27, CR = r2, SHGC =
0.28, VT - 0.52
Nail Fin Option - With Out i-Channel
LINE# DESCRIPTION QUANTITY U/M SHIP VIA NET PRICE EXTENSION
300-1 25-1000 1 Delivere $340.95 $340.95
Overall Unit size: Cummington supply d on NVP
13.75" X 83.75^ TrustGard Deadlite, Sash Set, Fixed, 13.75 z 83_14—k
Frame width = 13.75, Frame Height = 83.75
Rough: RO Deduction = -1/4" r -1/4", Replacement, Thermal Sash
Color = white
Overall RO Unit 1: Glazing Type = Low E, Low E Softcoat, Gas Flll = ��
14" X 04" Argon
Unit 1 Glass: Glass strength = Double Strength, Tempered
Tag/Room: = Yes
84" max height QB Series = 25, QB Item Number = 1000 Li
Unit 1: Unit CFD Number = NVP-K-24-00257-00001, Unit X3'4
U-Factor = 0.26, Unit SHGC - 0.32, Unit VT = 0.6, Unit CR �a•,.
65, Air Infiltration Rating = < 0.3 cfm/ft2, 'Meets
Energy Star = Yes �-
Unit 1 Glass: CPD Number = NVP-K-24-00257-00001, U-Factor
0.26, CR = 65, SHGC - 0.32, VT - 0.6
Page 2 Of 4
QUOTE# STATUS CUSTOMER PO# DATE CREATED
233614 Nine phillips rh erside 4/30/-
2019
QUOTED BY TERMS SHIP VIA PROJECT NAME
Breed I ehN erect on NVP Tnxl; Hamlm/rn erside
'-INE# DESCRIPTION QUANTITY U/M SHIP VIA NET PRICE EXTENSION
400-1 26-1100 1 Delivexe $200.90 $200.90
Overall Unit Size: cummington Supply d on NVP
TrustGard, Double Hung, Double Hung, 33.5 x 61.5Truck
93.s^ x s1.5^ Frame width = 33.5, Frame Height = 61.5, sash split
Rough: E,Ven _
RO Deduction = -1/4" x -1/4", New Construction, Thermal
Overall RO Sash aG
34" X 62" Color = white
Sash Reinforcement = Lock and Keeper Rail Only, composite
Tag/Room: Unit 1: Glazing Type = Low E, Low E Softcoat, Gas FI11 =
None Assigned Argon
Unit 1 Lower Glass, 1 Upper Glass; Glass Strength = x.3
Single strength R0 34
Lock Options = Double Lock, standard, white
Full Screen, Fiberglass
QB Series = 26, QB Item Number = 1100
Unit 1: Unit CPD Number = NVP-K-14-00740-00001, Unit
U-Factor = 0.27, Unit SHGC - 0.28, Unit VT = 0.52, Unit
CR - 62, Air Infiltration Rating = < 0.3 cfm/ft2, Meets
Energy Star = Yes
Unit 1 Lower Glass, 1 Upper Glass: CPD Number =
NVP-K-14-00740-00001, U-Factor = 0.27, CR = 62, SHGC =
0.28, VT = 0.52
Nail Fin Option - With Out J-Channel
LINE# DESCRIPTION QUANTITY U/M SHIP VIA NET PRICE EXTENSION
500-1 26-1100 2 Delivere $197.52 $395.04
Overall Unit Size: Cummington Supply d on NVP
TrustGard, Double Hung, Double Hung, 26 x 61.5 Truck
26" x 61.5^ Frame width = 26, Frame Height = 61.5, Sash Split - Even -
Rough: RO Deduction = -1/4" x -1/4", New Construction, Thermal
Sash
Overall RO Color = white pmt
26.5" X 62"
Sash Reinforcement = Lock and Keeper Rail Only, Composite Cr
Unit 1: Glazing Type = Low E, Low E Softcoat, Gas FIll =
Tag/Room: Axgon
None Assigned Unit 1 Lower Glass, 1 Upper Glass: Glass strength =
Single strength — 26 —
Lock Options = Double Lock, standard, White ko-les
Full Screen, Fiberglass
QB Series = 261 QB Item Number = 1100
Unit 1: Unit CED Number = NVP-K-14-00740-00001, Unit
U-Factor = 0.27, Unit SHGC = 0.28, Unit VT = 0.52, Unit
CR = 62, Air Infiltration Rating = < 0.3 cfm/ft2, Meets
Energy Star = Yes
Unit 1 Lower Glass, 1 Upper Glass: CPD Number
NVP-K-14-00740-00001, U-Factor = 0.27, CR = 62, SHGC =
0.28, VT = 0.52
Nail Fin Option = With Out J-Channel
Page .3 Of 4
QUOTE# STATUS CUSTOMER PO# DATE CREATED
23-3614 Noire phillips riverside 4/30/2019
QUOTED BY TERMS SHtP VIA PROJECT NAME
dreed Delivered onNVP Truck Hamlin/riverside
°ummington Supply's products are"made-to-order.' To achiei'e Ctmrrnington Suppl}'s short SUB-TOTAL: $2.612.81
lead time&xve begin production inri diately upon your order entry. Therefore.orders canrxot beLABOR: $0.0
larged and units camiot tie returned for credit. REIt;THT: $0.
lease check this quote thfiroughly and prorvptly for errors so Cumm in`4ton Supply can ensure SALES TAX: $U.
your order was entered as intended.Cummir�ton Supple will ask you to sign a confirmation on O TAL: 1 $2,612.81
�soxue units before xre proceed with producticm.
We appreciate the opportunity to provide you with this q te!
Custoni�er Signature:
Page 4 Of 4
eC5